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Progression of Myopic Maculopathy in Children and Adolescents With High Myopia
abstract
This abstract is available on the publisher's site.
Access this abstract nowIMPORTANCE
Individuals with high myopia younger than 18 years are at relatively high risk of progressively worsening myopic maculopathy. Additional studies are needed to investigate the progression of myopic maculopathy in this age group, as well as the risk factors associated with progression.
OBJECTIVE
To investigate the 4-year progression of myopic maculopathy in children and adolescents with high myopia, and to explore potential risk factors.
DESIGN, SETTING, AND PARTICIPANTS
This hospital-based observational study with 4-year follow-up included a total of 548 high myopic eyes (spherical power -6.00 or less diopters) of 274 participants aged 7 to 17 years. Participants underwent comprehensive ophthalmic examination at baseline and 4-year follow-up. Myopic maculopathy was accessed by the International Photographic Classification and Grading System. The data analysis was performed from August 1 to 15, 2023.
MAIN OUTCOMES AND MEASURES
The progression of myopic maculopathy progression over 4 years and associated risk factors.
RESULTS
The 4-year progression of myopic maculopathy was found in 67 of 548 eyes (12.2%) of 274 participants (138 girls [50.4%] at baseline and 4-year follow-up) with 88 lesion changes, including new signs of the tessellated fundus in 16 eyes (18.2%), diffuse atrophy in 12 eyes (13.6%), patchy atrophy in 2 eyes (2.3%), lacquer cracks in 9 eyes (10.2%), and enlargement of diffuse atrophy in 49 eyes (55.7%). By multivariable analysis, worse best-corrected visual acuity (odds ratio [OR], 6.68; 95% CI, 1.15-38.99; P = .04), longer axial length (AL) (OR, 1.73; 95% CI, 1.34-2.24; P < .001), faster AL elongation (OR, 302.83; 95% CI, 28.61-3205.64; P < .001), and more severe myopic maculopathy (diffuse atrophy; OR, 4.52; 95% CI, 1.98-10.30; P < .001 and patchy atrophy; OR, 3.82; 95% CI, 1.66-8.80; P = .002) were associated with myopic maculopathy progression.
CONCLUSIONS AND RELEVANCE
In this observational study, the progression of myopic maculopathy was observed in approximately 12% of pediatric high myopes for 4 years. The major type of progression was the enlargement of diffuse atrophy. Risk factors for myopic maculopathy progression were worse best-corrected visual acuity, longer AL, faster AL elongation, and more severe myopic maculopathy. These findings support consideration of follow-up in these individuals and trying to identify those at higher risk for progression.
Additional Info
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Four-Year Progression of Myopic Maculopathy in Children and Adolescents With High Myopia
JAMA Ophthalmol 2024 Mar 01;142(3)180-186, F Jiang, D Wang, O Xiao, X Guo, Q Yin, L Luo, M He, Z LiFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Jiang and co-authors reported the results from a 4-year longitudinal observational study that investigated the progression of myopic maculopathy (MM) in Asian children and adolescents. The current study was well-designed. By using the International Photographic Classification and Grading System for MM and with fundus photographic changes being correlated with visual acuity, axial length, and other eye metrics, the risk factors for MM progression were revealed. Such a straightforward approach is applicable to clinical and epidemiological studies. However, in real-world practice, the use of the photographic characteristics of MM as the main clinical markers may not be sensitive enough when monitoring young patients. Advanced imaging modalities, such as optical coherence tomography, may allow for the identification of early retino-choroidal signs that could serve as predictors of MM progression at the in vivo histologic level.
In revisiting the current data, it is important to note that only individuals with bilateral high myopia were recruited. In other words, each eye, considered an independent subject, was counted for the sample size (ie, per eye and not per person). Under this circumstance, if any asymmetric MM changes in each eye of an individual were particularly analyzed, the asymmetry of MM development, a frequent clinical phenomenon,1 would be informative of ocular, although not systemic, risk factors for MM progression.
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